Endotracheal tube position in the infant

doi:10.1016/S0022-3476(71)80429-8

The Journal of Pediatrics

Volume 78, Issue 6, June 1971, Pages 991-996

https://doi.org/10.1016/S0022-3476(71)80429-8 Get rights and content

The locations of endotracheal tubes were assessed radiographically in 36 of 52 intubated infants during a 11/2 year period. In 18 of the 36 patients for whom there were radiographs, the endotrached tubes were in one of the bronchi. Eleven of these 18 patients developed atelectasis. The effects of head motion and respiration on the position of the tube were also evaluated. Suggestions are given to ensure proper placement of an endotracheal tube and for maintenance of the tube in the trachea.

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There are more references available in the full text version of this article.

Cited by (79)

50 Years Ago in THE JOURNAL OF PEDIATRICS: An Ongoing Feat: Assessing Proper Endotracheal Tube Position in the Neonate
2021, Journal of Pediatrics
The Oro-Helical Length Accurately Predicts Endotracheal Tube Insertion Depth in Neonates
2018, Journal of Pediatrics
Reexamining the ideal depth of endotracheal tube in neonates
2018, Pediatrics and Neonatology
Citation Excerpt :
All were related to inadequacies of ET tip placement. Neonatologists struggled with optimum placement of the ET.8 Deep ET position in 7–58% of neonatal postintubation radiographs was still reported under use of the rule of 7-8-9,9,10 while shallow ET placement occurred less frequently.11
The appropriate endotracheal tube (ET) depth for the newborn with respiratory failure is important. Inappropriate ET depth increases the risk of uneven lung expansion and collapse. This retrospective study aimed to compare the final ideal ET depth with Tochen's formula in Taiwanese intubated neonates, and to determine the correlation between neonatal factors and final ideal ET depth, and to devise an accurate predictive formula for use in Taiwan.
Data were collected from neonates who required endotracheal intubation and who were admitted to the Neonatal Intensive Care Unit from 2011 to 2015. Correlations between the final ideal ET depth, GA, and BW were assessed using the Pearson correlation test. Multiple regression analysis was used to produce a formula to predict appropriate ET depth from mouth angle to midtracheal position of neonates.
A total of 139 neonates were enrolled in this study. The final ideal ET depth was in concordance with Tochen's formula only in 19 neonates (13.7%); relatively deeper in 30 (21.6%) neonates; and shallower than the values from Tochen's formula in 90 (64.7%) neonates. Multiple regression analysis showed that the BW and GA together produced best prediction for final ideal ET depth in our study population. SGA and gender were shown to be insignificantly related to final ideal ET depth.
Our study showed the final ideal ET depth was shallower than Tochen's formula in 64.7% of neonates. Tochen's formula might not be suitable to predict ET depth for neonates in Taiwan. In our study, the new formula: 4.0 + 1.0 BW (kg) + 0.05 GA (weeks) provides a more accurate value and alternative method for evaluating the final ideal ET depth in Taiwan. A practical guideline for Asian neonates should be validated by prospective studies with large sample sizes.
A new method for determining the insertion depth of tracheal tubes in children: A pilot study
2016, British Journal of Anaesthesia
Citation Excerpt :
Currently used formulas for tracheal tube length are based on age, body weight and height. All formulas have shown limitations in different age groups.1–3 There are only limited data and no follow-up clinical studies confirming safety and appropriateness of published formulae.12
Choosing the correct insertion depth of tracheal tubes is crucial for successful airway management in paediatrics. Currently used formulas are based on patient characteristics such as age, body weight and height. The aim of the study is to devise and evaluate more suitable body surface area based diagrams for predicting the correct tracheal insertion depth.
Calculated insertion depth according to currently used formulas, primary insertion depth and insertion depth corrected by chest radiography (‘gold standard’) were collected from 237 children. Age, body weight, height and body surface area were noted. Body surface area based diagrams were devised and prospectively evaluated in another set of 123 paediatric patients.
Tracheal tube position according to currently used formulas had to be corrected in 37% of all intubations. New body surface area based diagrams were created. In 20.3%, depth of the tracheal tube had to be corrected according to the new body surface area based diagrams.
The body surface area based diagrams may be a reliable tool for predicting the correct tracheal insertion depth in children.
Automated detection of endotracheal tubes in paediatric chest radiographs
2015, Computer Methods and Programs in Biomedicine
Citation Excerpt :
Hence confirmation of correct tracheal tube placement is an important procedure. To ensure that the endotracheal tube is ideally placed for proper ventilation, the current gold standard for confirming tube position is a chest radiograph [6,7]. A chest radiograph can be used to confirm the correct tube position within the trachea, which should be just below the level of the vocal cords and well above the carina.
The aim of this study was to develop an automated method for the detection of endotracheal tube and location of its tip in paediatric chest radiographs. In this method, a seed point was first determined from the line crossing the cervical region and a line path was traced from the seed point. Two features, L_max and C, were determined from the path and were combined to detect the existence of the endotracheal tube. Multiple thresholds applied to the line path were used to determine the candidate locations for the tip, and the most suitable location was selected from these candidates by analysing the image features. To evaluate the performance of detection of endotracheal tube existence, support vector machine was used to classify the images with and without endotracheal tubes on the basis of L_max and C. The discriminant performance of the method was evaluated using receiver operating characteristic (ROC) analysis. To evaluate the precision of the detected tip locations, the tip locations in paediatric chest images were annotated by a radiologist. The distance (error) between the detected and annotated locations was used to evaluate detection precision for the tip location. The proposed method was evaluated using 528 images with endotracheal tubes and 816 images without endotracheal tubes. The discriminant performance in this study, evaluated as Az (area under the ROC curve), for detecting the existence of endotracheal tubes on the basis of the two features was 0.943 ± 0.009, and the detection error of the tip location was 1.89 ± 2.01 mm. The proposed method obtained high performance results and could be useful for detecting the malposition of endotracheal tubes in paediatric chest radiographs.
Confirmation of correct tracheal tube placement in newborn infants
2013, Resuscitation
Tracheal intubation remains a common procedure during neonatal intensive care. Rapid confirmation of correct tube placement is important because tube malposition is associated with serious adverse outcomes. The current gold standard test to confirm tube position is a chest radiograph, however this is often delayed until after ventilation has commenced. Hence, point of care methods to confirm correct tube placement have been developed. The aim of this article is to review the available literature on tube placement in newborn infants. We reviewed books, resuscitation manuals and articles from 1830 to the present with the search terms “Infant, Newborn”, “Endotracheal intubation”, “Resuscitation”, “Clinical signs”, “Radiography”, “Respiratory Function Tests”, “Laryngoscopy”, “Ultrasonography”, and “Bronchoscopy”. Various techniques have been studied to help clinicians assess tube placement. However, despite 85 years of clinical practice, the search for higher success rates and quicker intubation continues. Currently, chest radiography remains the gold standard test to confirm tube position. However, rigorous evaluation of new techniques is required to ensure the safety of newborn infants.

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^*: Address: Division of Pediatric Radiology, C. S. Mott Children's Hospital, Ann Arbor, Mich. 48104.

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Original articleEndotracheal tube position in the infant

Lancet

Lancet

Complications during endotracheal anesthesia

Anesth. Analg.

Complications of endotracheal intubation

Amer. J. Roentgen.

Original article
Endotracheal tube position in the infant